| NPI | 1023038288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P10585) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 016588) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2009-01-26 |